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Home My WebLink AboutBUSINESS PLAN.CAL WATER SRVC (197-01) 7301 MELETA COURT -- ~~ ~~~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF ,PERMIT ON REVERSE SIDE Permit ID#:: 015-000-001943 CALIFORNIA WATER This _=ermit is Issued for the followfn9; [] Hazardous Mateflals Plan n Underground Storage of Hazardous Materials [] Risk Management Program [] H~rdous Waste On-Site Treatment LOCATION: 7301 MALETA CT Issuedby: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: Iiv Office of Ev~$ervices '"' June 30; 2003 issue Date ~_- ~,'~q~) RY. W g'~MET. E- 7171-R3 14' ~1 . CALIFORNIA WATER SRV 197-O1 Manager TIM TRELOAR Location: 7301 MELETA CT City BAKERSFIELD CommCode: KCFD STA 61 EPA Numb: SiteID: 015-021-001943 BusPhone: (661) 837-7200 Map 102 CommHaz High Grid: 16C FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact BILL TRELOAR Business Phone: 24-Hour Phone Pager Phone Hazmat Hazards: / Title / DISTRICT MGR (661) 837-7200x (661) 837-7200x ( ) - x Contact BILL ROSICA MailAddr: 3725 S H ST City BAKERSFIELD Owner CALIFORNIA WATER SERVICE CO Address 3725 S H ST City BAKERSFIELD Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of those individual,; responsible for obtuininc~ the information, I certify under penalty of law that i have personal,y examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~ ~~ S' ature Dat Phone: (661) 837-7200x State: CA Zip 93304 TotalASTs: _ TotalUSTs: _ RSs: No ENT ~~~ 2 0 200 Gall Gal Emergency Contact RUDY VALLES Business Phone: 24-Hour Phone Pager Phone / Title / ASST DIST MGR (661) 837-7271x (661) $37-7271x ( ) - x Fire Press ImmHlth Phone: (661) 837-7278x State: CA Zip 93304 -1- 07/10/2007 F CALIFORNIA WATER SRV 197-01 SiteID: 015-021-001943 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 07/10/2007 -3- o~/io/aoo~ F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-001943 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 Liquid TMixture ~ Ambient~E ~ A~PeRATURE ABOVEOGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL ruyaru~LV~~ ~.vi~irviv~l~t~ %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 r].1'iL~l-iRL H. 7.7 P~.7 ~J1.1r,1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 07/10/2007 .L, ~ F CALIFORNIA WATER SRV 197-01 SitelD: 015-021-001943 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/16/2006 ~ CALL 911 AND 800-852-7550 OR 916-427-4341. ,_ L'ILl~J1VyCC 1VV 1.11. / L' VdC.:LLdL1V11 Public Notif./Evacuation 05/16/2006 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION, AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan 08/07/2006 MERCY HOSPITAL. -5- 07/10/2007 F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-001943 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/16/2006 ~ SODIUM HYPOCHLORITE IS STORED IN AN ABOVEGROUND SECURE AREA. Release Containment 04/30/1999 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. ,., ~.icall vN V1.11C 1. 1CC w7VU1 l:C L'il.L1VGY 1.1 Vll -6- 07/10/2007 F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-001943 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCC:td1 Lld'Gd,LC15 Utility Shut-Offs ELECTRICAL - SERVICE BOX INSIDE FAC 05/23/2007 Fire Protec./Avail. Water FIRE HYDRANT - WELL DISCHARGE. 08/07/2006 Building Occupancy Level UNMANNED SITE 05/16/2006 -7- 07/10/2007 .._ F CALIFORNIA WATER SRV 197-01 SiteID: 015-021-001943 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/26/2007 ~ MSDS SHEETS ON FILE. BRIEF SiTMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE CO PROVIDES THE FOLLOWING TRAINING: SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE; HAZARD COMMUNICATION STANDARD; EVACUATION PROCEDURES; PROPER HANDLING OF HAZARDOUS MATERIALS; AND HMMP IMPLEMENTATION. rays ~ Held for Future Use nciu ivi ru~uic vac -8- 07/10/2007 Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST B e R s F ,_ D 900 Truxtun Ave., Suite 210 ~~__~:. .~ _.._. ~~ _ _ ____V. ~ _ r _-.__ . _. _ FIRE Bakersfield, CA 93301 SECTION 1.: Business Pian and Inventory Program 1= ARTM r Tel.: (661) 326-3979 ii ~ Fax: (661) 872-2171 FACILITY NAME INSPEC ON DATE INSPECTION TIME ADDRESS PHONE NO. ~f' NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- ~ 1~ - ~~ ~ ~ ~ ~ Sec#ia~ 1:~ Business Plan anct Inyen~c~ry Progre~rt OUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf'IeSS PLAN CONTACT INFORMATION ACCURATE ~[~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~~~ ~ ~ ~~(~~ ~j ^ VERIFICATION OF LOCATION ~ ^ PROPER SEGREGATION OF MATERIAL \ ~.J ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ~y` ~~~ ~ C 2 ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES `~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ~,(n~ ~" _ h- V 4/ a/~C,~ ~ ,~ . ,~ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~ NO Rtlh-OU IJ EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 r,~G rL~~ ~ ~~ Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/Station # B ess Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 CALIFORNIA WATER SRV 197-01 SiteID: 015-021-001943 Manager TIM TRELOAR Location: 7301 MELTA CT City BAKERSFIELD CommCode: KCFD STA 61 EPA Numb: BusPhone: (661) 837-7200 Map 102 CommHaz High Grid: 09B FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact BILL TRELOAR Business Phone: 24-Hour Phone Pager Phone. Hazmat Hazards: / Title / DISTRICT MGR (661) 837-7200x (661) 837-7200x ( ) - X Contact BILL ROSICA MailAddr: 3725 S H ST City BAKERSFIELD Emergency Contact RUDY VALLES Business Phone: 24-Hour Phone Pager Phone / Title / ASST DIST MGR (661) 837-7271x (661) 837-7271x ( ) - x Fire Press ImmHlth Phone: (661) 837-7278x State: CA Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 837-7200x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to Preparers Certif ' d: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Q'~~. 2 6 v ature Da e ENTq F~ B 2 3 ~®O 7 Gal Gal TotalASTs: _ TotalUSTs: _ RSs: No -1- 01/29/2007 ~~ • t F CALIFORNIA WATER SRV 197-01 SiteID: 015-021-00193 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MAP SODIUM HYPOCHLORITE F P IH L 200.00 GAL ~i -2- O1/29/~007 S -3- O1/29/Z007 ,l '1 ~ ~ F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-001943 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 Liquid TMixtur~Ambient~E ~ AmbientT~E ABOVEOGROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 200.00 GAL 200.00 GAL 200.00 GAL rlr~,~t~tcl~vu~ ~vl~irulvl;lvi~ %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 tiH:GHKL Aa~1;~a1~1L"1V1".5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MC1 No No No No/ Curies F P IH / / / Hi -4- 01/29/2007 i ~ 'a •, f. F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-00193 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/16/2005 ~ CALL 911 AND 800-852-7550 OR 916-427-4341. ~ Employee Notif./Evacuation Public Notif./Evacuation 05/16/2006 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION, AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan MERCY HOSPITAL. 08/07/20175 -5- 01/29/3007 F CALIFORNIA WATER SRV 197-O1 SiteID: 015-021-001943 ~ Fast Format ~ ~ Mitigation/PreventjAbatemt Overall Site ~ ~ Release Prevention 05/16/206 ~ SODIUM HYPOCHLORITE IS STORED IN AN ABOVEGROUND SECURE AREA. Release Containment 04/30/1999 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. l.1 CC111 V~J Vl-11C1 itC w7V U1. l..C tit~lrlVCL l.1 V11 -6- O1/29/~007 F CALIFORNIA WATER SRV 197-01 SiteID: 015-021-0019.3 ~ Fast Format ~ ~ Site Emergency Factors Overall Sites ~ _, _,_ Vj.JG1.10.1 R0.G 0.11.17 Utility Shut-Offs 08/07/2006 A) ELECTRICAL - SERVICE BOX INSIDE FAC B) LOCK BOX - NO Fire ProteC./Avail. Water 08/07/2006 FIRE HYDRANT - WELL DISCHARGE. Building Occupancy Level 05/16/20176 UNMANNED SITE r -7- 01/29/2007 ,. ~~ F CALIFORNIA WATER SRV 197-01 SiteID: 015-021-00193 ~ Fast Format ~ ~~Training Overall Site ~ ~ Employee Training 05/16/2017 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE CO PROVIDES TI~$ FOLLOWING TRAINING: 1. SAFETY PROCEDURES. IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE. 2. HAZARD COMMUNICATION STANDARD. 3. EVACUATION PROCEDURES. 4. PROPER HANDLING OF HAZARDOUS MATERIALS. 5. HMMP IMPLEMENTATION. rayc ~. Held for Future Use RC1U 1V1 tUI.ULC V.7C -8- O1/29/~007 r-P _ F '_ + CALIFORNIA WATER SRV 197-01 _________________________ SitelD: 015-021-001943 + g3~-7~wr~ Manager BusPhone : ( 661) ~~~6-~-4•@~ Location: 7301.MELTA CT Map 102 CommHaz High City BAKERSFIELD Grid: 09B FacUnits: 1 AOV: CommCode: KCFD STA 61 EPA Numb: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title BILL TRELOAR / DISTRICT MGR +~~dy ~~ p~ / ASST DIST MGR Business Phone : ( 6 61) 9~2~-8.9~~37- ~~c~ Business Phone : ( 6 61) 3~-~6~ $3') ~ ?L j 2 4 -Hour Phone ( 6 61) 3 9-~-~-2-~-+/3~ -7~cv 2 4 -Hour Phone ( 6 61) '3 9 0 ~?-4~^~~ ~3~ ~ 1Z 7 ~ Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact ~+ j ~ ~a5 i~C{1• Phone : ( 6 61) ~~6-~2.4-@~9~ MailAddr: 3725 S H ST State: CA ~37~-7z..7~y City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 396-2400x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK vl o~ ~ ~ o Based gn my inquiry pf those individuals 56 responsible fir obtaining the information, 1 certify ~f under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. (T ~-~R'-C•~ J Z 2 CiM~ S' ature Date ENT A U ~ 0 7 2006 -1- 05/16/2006 + CALIFORNIA WATER 'i'STA197 Manager : M~ ,Location: 7301 MALETA CT WCity BAKERSFIELD CommCode: COUNTY STATION 66 EPA Numb: SiteID: 015-021-001943 + BusPhone: Map : Grid: (661) 396-2400 CommHaz : Moderate FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title MRLlgIN BYRD / DISTRICT MGR Business Phone: (661) 962-4000x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Emergency Contact / TIM Tg~I,OA9 / Business Phone: (661) 24-HoUr Phone : ( ) Pager Phone : ( ) Title .... I ASSIST DiST ~u~ 396-2400~_ - X Hazmat Hazards: Fire Press ImmHlth I Contact : FfE~N--~DAP~D Phone: (661) 396-2400x MailAddr: 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Phone: (661) 396-2400x I Address : 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal a~l~Certif'd: RSs: No ~arcelNo: Emergency Directives: District Manager-Tim Treloar Asst. District Manager-Bill Harper Contact Person-Tamara Johnson Same Phone Numbers ==+ 1 07/30/2003 CALIFORNIA WATER SERV CO STA197 Manager : MEL BYRD Location: 7301 MALETA CT City : BAKERSFIELD CommCode: COUNTY STATION 66 EPA Numb: SiteID: 015-021-001943 BusPhone: (661) 3 ~6/% 4~0 Map : CommHaz : Moderate Grid: FacUnits: 1 AOV: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title MELVIN BYRD / DISTRICT MGR Business Phone: (661) 962-400 x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Emergency Contact TIM TRELOAR Business Phone: 24-Hour Phone : Pager Phone : / Title / ASSIST DIST MGR (661) 396-2400x ( ) - x ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : MELVIN BYRD MailAddr: 3725 S H ST City : BAKERSFIELD Phone: (661) 396-2400x State: CA Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Address : 3725 S H ST City : BAKERSFIELD Phone: (661) 396-2400x State: CA Zip : 93304 Period : Preparer: Certif'd: to TotalASTs: = Gal TotalUSTs: = Gal RSs: No Emergency Directives: = Hazmat Inventory --As Designated Order Hazmat Common Name... CHLORINE ~yl~ or pn'm name) reviewed the attached hazardous materials manage- One Unified List Ail Materials at Site ISpooHazlEPA HazardsI Frm DailyMax UnitlMcP F P IH L 200.00 GAL Ext Do hereby certify that ~ have ment plan for r_,_u s and that it aloncj with (Name of ~}usine~S) any corre~ions constitute ~ complete and ~rre~ m~n- agement plan for my facility. Date 1 07/19/2000 CALIFORNIA WATER SERV CO STA197 SiteID: 015-021-001943 Inventory Item 0001 Facility Unit: Fixed Containers at Site ~lVUVl~ N~Vl~ / ~ ~ ~.~-k. EJ CHLORINE Days On Site SODIUM HYPOCHLORITE 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7882-50-5 FSTATE TYPE Liquid I Pure PRESSURE TEMPERATURE Above Ambient I Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 200.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 200.00 GAL Daily Average 200.00 GAL %Wt . 12.50 HAZARDOUS COMPONENTS Sodium Hypochlorite RNo~ CAS#7681529 TSecret No S BioHaz N No HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F P IH NFPA /// -2- 07/19/2000 CALIFORNIA WATER SERV CO STA197 SiteID: 015-021-001943 Fast Format = Notif./Evacuation/Medical --Agency Notification CALL 911 AND (800) 852-7550 OR (916) 427-4341. Overall Site 04/30/1999 -- Employee Notif./Evacuation N/A - IINMANNED SITE. 04/30/1999 -- Public Notif./Evacuation 04/30/1999 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION AS NECESSARY, IF EMERGENCY SERVICES ~PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan MEDICAL ASSISTANCE WOULD BE PROVIDED BY MERCY HOSPITAL. 04/30/1999 -3- 07/19/2000 CALIFORNIA WATER SERV CO STA197 SiteID: 015-021-001943 Fast Format ~ Mitigation/Prevent/Abatemt --Release Prevention Overall Site 04/30/1999 SODIUM HYPOCHLORITE IS STORED IN AN ABOVE GROUND SECURE AREA. --Release Containment 04/30/1999 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. -- Clean Up Other Resource Activation -4- 07/19/2000 CALIFORNIA WATER SERV CO STA197 SiteID: 015-021-001943 Fast Format Site Emergency Factors Special Hazards Overall Site --Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - SERVICE BOX LOCATED INSIDE FACILITY C) WATER - N/A D) SPECIAL - N/A E) LOCK BOX - NO 04/30/1999 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ????????? 04/30/1999 NEAREST FIRE HYDRANT - ON SITE WELL DISCHARGE. Building Occupancy Level -5- 07/19/2000 CALIFORNIA WATER SERV CO STA197 SiteID: 015-021-001943 Fast Format Training -- Employee Training WE HAVE NO EMPLOYEES AT THIS FACILITY IT IS AN UNMANNED SITE. Overall Site 04/30/1999 WE DO HAVE OUR MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE COMPANY PROVIDES THE FOLLOWING TRAINING : 1. SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE. 2. HAZARD COMMUNICATION STANDARD. 3. EVACUATION PROCEDURES. 4. PROPER HANDLING OF HAZARDOUS MATERIALS. 5. HMMP IMPLEMENTATION. -- Page 2 -- Held for Future Use Held for Future Use 6 07/19/2000 INSTRUCTIONS: 2. 3. 4. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 To avoid further action, remm this form within 30 days ofrecdpt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA LOCATION: 73,0l f MAILING ADDKESS: ~-7 2,..~ .~r~ . lq? CITY: DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: ~/~. ~"~ ~--- MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION,3: TRAININ0 NUMBER OF EMPLOYEES: . b,~ o~ -- Uu~asw,s~D~r~ MATERIAL SAFETY DATA SHEETS ON FILE: SECTION 4: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERIURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION l, ~ ~-'~r~¢~ CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES AGENCY NOTIFICATION PROCEDURES: Bo EMPLOYEE NOTIFICATION 'AND EVACUATION: EMERGENCY MEDICAL PLAN: I~A~..~c,~ L A~:~-~,r'~-r~'~c-~ ,,~ o~'~ ~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: ~ot>,~4 ~-~'r'~OCH I--C~ B0 RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: WATER~: SPECIAL: LOCK BOX: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: YES~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: WATER AVAILABILITY (FIRE HYDRANT): 4 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) ;326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] FACILITY NAME ,~7'/;E /~/7 CITY ~~~m~ STA~ ~. SIC CODE DUN & BRAI)STREET NUMBER OWNER/OPERATOR M_AH.ING ADDKESS ~'7 CITY STATE C~:~. zip ~ o~ EMERGENCY CONTACTS BUSINESS PHONE NAME q-I~-n q--~-~--~,-~ BUSINESS PHONE TITLE Dt~a-~, c'r~A.~.,~.~ 24 HOUR PHONE '~.~'N4~. TITLE ~.C, ~-~uv ~.~-,-~,e~- [Vl,~,c,~ 24 HOUR PHONE ~' ~-- CI~M/CAL D~CRIF/'ION .PaEe ~_~ of~ / I)INVEKTORYSTATUS:New[~Addition[ ]Revision[ ]Deletion[ 2) Common Name: O~-I 4 ) PhysicaJ & Health PHYSI~ 51 ,,z ~,~-~ HEALTH Hazard Catesones Fire [ ] Reactive [ ] Suddeu Release of Pressure [ ] Immediale Health (Acute) [ 5) WASTE CLASSIFICATION Check if chemical is a NON Tnde Secret D(,] Trade Secret [ ~) DOT # (optional) , (3-digit code from DHS Form 8022) USE CODE ] DeU,~ He~a, (Ch,~ic) ix/.j PHYSICAL STATE Solid [ ] Liquid l~l oas [ I PureD~l Mixture[ I Waste[ I Redioe~ve[ I 7) AMOUNT AND TIME AT FACE.ITY Max/mum Daffy Amount Average Daily Amount Annual Amount Largest Size Container · # Days on Site ~ uNrrs OF IVIFASURE 8) STORAGE CODES Lbs[ ]C, al[~]i~[ ] a)Containe~. Curies [ ] b) Pressure c) Temperature Circle W~ich Months: AIl Year, J, F, 1~ A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the ~ most ha/ardous i) [ ] chemical components or 2) [ ] any AHM components 3) [ ] 10)LOCATION [~---~lc~_./~ ~..l,,.l~(._l~..ll~--.~_. 'l,4~__~/_-r" ~ ~t~ I)~ORYSTA~S:New[ ]Addition[ ]Revision[ ]~leUon[ ] Ch~kifch~isaNONTradeS~[ ]T~ [ ] 3) ~T ~ (option) , , 2) Common Name: · Chemical Name: .-~[IVi [ ] CAS fl ..... 4) Physica{ & Health PHYSICAL Hazani Categories Fke [ ] ReacUve [ ] Sudden Release of Pressure [ ] ImmedialeH~"Acute) [ ] Delayed I-I~th (Chn~c) [ ] 5) WASTE CLASSIFICATION .... (3-digit code ~om DHS Form~.. U~E~O.D.E. ~~ _ 6) PHYSICAL STA'I~E Solid[ ] Liquid[,], Gas[ ] /~e[ ]./ Mixture[ I Waste[ ] Radioactive[ ] 7~ AMOUNT A.\'D TBME A'F FACIIITY L,'NITS.~OF .~.~F_ASURE 8) STORAGE CODES MmNlmum Daily Amount __ Lb~M/'I Ga{ [ ] it3 [] a) Conuime~. Average Daily Amount ~ CUries [ ] b) Pressure: Annual Amount __~,~ c) Temperature L~ugest Size Con~cr # Da~'s on Site j Ch'cie ~3,lUch Months: All YcaL $, F, M, A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardo.~' 1) r chenucal compon...~t~ or 2) [ ] any AI-l~~ents 3) [ ] I c, er~if~ under penait~ of law. that I have personally examined an.d am fiuniliar with the inlbrmation on dtis and all a~ d~umen~ I believe the submitted intbrmation is true, accurate and complete. ~=-~& ~ /-'"-~ .~_~_~ PRINT Name & Title of AuthOriZed Company R~taUve Signature Dnle